What to prepare for your first counseling session:
Whether you have been to therapy/counseling before or not, that very first session with a psychologist (therapist, professional counselor, social worker etc.) can create a good deal of anxiety and uncertainty of what to expect. So, I am writing this blog post to give you a better sense of what to expect with most intake sessions, with the emphasis on ‘most’ since all of us do things a little differently. I myself get a bit anxious too before a new patient because I want to ensure new patients are comfortable and can get a good sense of what working with me will be like after that first short hour together. I am looking for fit too- I will 100% admit I am not everyone’s cup of tea. It is better for both parties to figure that out sooner rather than later. I would much rather refer a patient out to someone who will be a better fit than to try and force a therapeutic alliance.
Of course, there’s going to be some fun paperwork and legal- smegal stuff to do upfront. This is mostly privacy practices (like HIPPA) and confidentiality and the limits of it.
Then…
Lots of intrusive questions to gauge what is going on and where I feel I can help you. I must practice within my scope of training and experience, so if you have something I am not well versed or formally trained in, I likely am going to try and find another provider who is. Sometimes this gives a feeling of “being passed off”, but that is nowhere near the reason for referring someone out.
Common questions to think about beforehand:
Write down your symptoms so you aren’t feeling pressured on the fly
Write down medications and dosages, or bring the bottles
How are your symptoms disrupting daily functioning (how are they preventing you from living your best life?)
Past counseling experiences- were they helpful? What did you like/not like? What did you take away from those experiences?
Medical and /or psychological diagnoses current and in the past
What is your family like? What was it like growing up? Are you/were you close with family members? How have they potentially contributed to your problems?
Are you in a romantic relationship? Is it supportive and safe?
What is your support network like? Do you have friends you can go to in times of need? Or other outlets for dealing with issues if you’re more introverted?
Are you coming to therapy because YOU want to or is someone coercing you to be here? If the latter, it’s something for us to really process- without an open mind and self-motivation, counseling is likely going to feel like a waste of time
Substance use- is it getting in the way of your daily functioning or making you feel bad about yourself?
What were your school years like? How were your grades? Any developmental issues you are aware of that you may have had as a kid?
Any history of events/experiences you considered traumatic?
Any suicidal thoughts? Just because you say yes, DOES not mean I will hospitalize you. I will probe more to make sure you are safe, but hospitalization is always a last resort in my mind to keep you safe.
Any aspects of your identity you feel contribute to your problems?
What ways have you tried to manage your symptoms, if any? (Coping strategies)
What do you like to do for fun? What makes you tick?
What are you looking to get out of counseling? What are your expectations of your psychologist/therapist/counselor?
How would you know if counseling was working? What changes would you need to see?
What barriers might you have that would prevent actively engaging in treatment?
What questions do you have for the provider? I am an open book mostly and happy to answer questions about myself. I think it is only fair when you are coming in meeting a stranger and expected to tell me your deepest darkest fears, secrets, all kinds of things you can’t tell anyone else.
Mythbusting counseling:
These are some of the most common myths I have had to try and “bust” over the years:
MYTH: Only “Crazy” people go to counseling.
Most people who seek counseling are ordinary everyday people, not violent, dangerous, and “crazy”. Counseling can help you cope with everyday stress, improve relationships, broaden your perspective and give you more clarity and direction in order to achieve your goals.
MYTH: People Who Go to Counseling Are “Broken”, “Emotionally Damaged”, “Weaker”.
Everything may not be perfectly fine 24/7/365 in your life, but that doesn’t mean you’re broken or emotionally damaged. Counseling is a tool for people to explore themselves and learn to improve oneself and their life. Going to counseling can be looked at as preventative, not only when you’re at “rock bottom.” Asking for help is not a sign of weakness. It just means that you’re taking action. Actually, knowing when to ask for help is actually a sign of strength and self-awareness. Counseling is a place that provides you a safe and confidential place to talk openly and freely and identify and build on the strengths you already have.
MYTH: You’ll Prescribe or Make Me Take Meds
As a Psychologist, I am not allowed to prescribe medicine. If I feel that you may benefit from medication, I may offer it and provide you with appropriate referrals. I look at medication as a last resort in most cases too. Ultimately, the decision to take medication is yours.
MYTH: Counseling Is Easy and Just About Venting
This is so very far from the truth. Counseling is challenging, it involves making a commitment to yourself. Venting can feel good after it’s done, but usually this feeling is temporary and research shows complaining makes us feel worse in the long run. In counseling, venting may be productive at times to identify certain stressors and problem behaviors and areas, but keep in mind counseling should be working towards a specific goal(s) collaboratively identified that is measurable. Insurance companies require there to be “medical necessity” to behavioral health treatment, which also translates to counseling needing to be much more than venting.
MYTH: You Have to “Fix Me” for This to Be Worthwhile
I do wish I had a magic wand, would make life so much easier…I can help guide you in the journey to feeling better through learning coping skills, providing education, and processing what’s going on in your life. However, we do not provide answers or advice. We believe that you know yourself and your life best. The decision to work on yourself is very tough work, and ultimately you are the one responsible for doing the work. I am there to process and guide you through any obstacles or barriers you may face, but you have to have patience with the process and everyone is going to have different types and lengths of counseling. Sometimes you may feel worse after an intense session and that usually means it is working because you are feeling and opening up about your struggles.
MYTH: Counseling Does Not Work
Research demonstrates that counseling is effective for a variety of mental and behavioral health problems and across a variety of diverse groups of people. Counseling teaches patients life skills that last beyond the course of treatment. The results of psychotherapy tend to last longer than psychopharmacological (medicine) treatments and rarely produce any harmful side effects. It will only not work if you go in with such a mindset or do not actively participate.
Concluding Remarks
After the first session, you likely have a good indication of the alliance. If you have an overall good feel, but some qualms, bring them up with me in the following session. At any point in time if something feels off, tell me. I can always change my approach to fit your needs, but I won’t know something is wrong unless you speak up and advocate. I got thick skin, you won’t hurt my feelings! The therapeutic alliance supports the best experiences in therapy, this is heavily backed by a ton of research. This is collaborative, we are equals going toward the same goal- helping you feel like your best self and making the most out of your life. Hopefully, this post demystified some of your concerns about seeking counseling.
Yours truly,
Dr. Steele-Wren